Drug companies and doctors have been accused of fueling the opioid crisis, but some question whether insurers have played a role, too.

By KATIE THOMAS and CHARLES ORNSTEINSEPT. 17, 2017, New York Times Health

This article was written through collaboration between The New York Times and ProPublica, the independent, nonprofit investigative journalism organization.

At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.

The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive.

Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. That may be changing, however. The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis.

ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them.

In contrast, almost every plan covered common opioids and very few required any prior approval.

The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found.

by Larry Husten, CardioBrief August 29, 2017, MedPage Today & American College of Cardiology

BARCELONA — An enormous prospective study of food intake in adults, reported here, challenges several staunchly held beliefs about dietary components and their association with health risks: finding, for example that diets rich in fats, including saturated fats, don’t increase mortality risk, but high-carbohydrate diets do.

And the study, called PURE (Prospective Urban Rural Epidemiology), also found that the benefits of fruits, vegetables, and legumes top out at just three to four total servings per day.

In sum, the results suggest that nutritional guidelines and conventional wisdom regarding these basic dietary elements may be seriously mistaken.

PURE investigators recorded food intake using questionnaires in 135,000 people in 18 countries, including high-, medium- and low-income nations. The latest findings from the ongoing study, with median follow-up of 7.4 years, were outlined in two separate presentations at the European Society of Cardiology meeting here, which were accompanied by simultaneous publications in The Lancet and in Lancet: Diabetes & Endocrinology.

Carbohydrates and Fats: Unexpected Findings

One presentation and Lancet paper led by Mahshid Dehghan, PhD, of McMaster University in Hamilton, Ontario, focused on the association of fats and carbohydrate intake with cardiovascular disease and mortality.

Defying expectations, PURE found that high carbohydrate intake was associated with a significant increase in the risk of death, while both total fat and saturated and unsaturated fats were associated with a decreased risk of death. However, fat consumption was not associated with cardiovascular disease or cardiovascular mortality, though saturated fat had an inverse association with stroke.

“Global dietary guidelines should be reconsidered in light of these findings,” Dehghan concluded.

These findings may be partly explained by the paper in Lancet: Diabetes & Endocrinology, which looked at the effect of dietary nutrients on lipids and blood pressure. The authors found that high intake of carbohydrates had “the most adverse impact on cardiovascular risk factors” while monounsaturated fats had a beneficial effect and saturated fat had a neutral effect.

“Reducing saturated fatty acids and replacing them with carbohydrates might have an adverse effect on cardiovascular disease risk,” they concluded. “Current recommendations to reduce total fat and saturated fatty acids in all populations, which de facto increases carbohydrate intake, are not supported by our data.”

Fruits, Vegetables, Legumes: Benefits Limited

The second presentation and Lancetpaper, by Andrew Mente, PhD, also of McMaster University, challenges the widely held and nearly religious belief that more is always better when it comes to fruits, vegetables, and legumes.

The study did confirm that fruits and veggies (and legumes) in moderation are good for you, but it did not show that the benefits keep growing with increased consumption. Instead, the PURE researchers found that the maximum benefit was achieved with three to four serving per day. Current guidelines recommend that people consume five servings a day. The authors note that many people in lower income countries are unable to afford this high level of consumption.

“Optimal health benefits can be achieved with a more modest level of consumption, an approach that is likely to be much more affordable,” write the PURE investigators.

Hospitals spend millions on security and uncompensated care costs for victims of violence, according to a new report.

Providers spend billions of dollars preparing for and responding to violence both inside and outside of hospitals. That number includes losses from uncompensated care, added security spending and more, according to a new report.

The researchers divided costs into four groups: preparedness and prevention for public violence, post-incident public violence costs, preparedness and prevention for violence in healthcare facilities, and costs following a violent incident in a health facility.

Hospitals spent $1.1 billion shoring up security in their own facilities in advance of a violent incident, and about $429 million in medical care, indemnity, staffing and other costs following one. About $280 million went toward prevention programs for community violence, and the final $852 million covered uncompensated care and utilization review costs for victims of violence.

Healthcare workers are at significant risk for workplace violence—between 2011 and 2013, nearly 75% of workplace assaults took place in healthcare settings. Nurses are in particular danger. Workplace violence is also an underreported problem, and executives have been criticized for not making it easier for employees to report assaults or other incidents.

Hospitals are also on the front lines of responding to community violence and play an important role in prevention, according to the report. AHA President Rick Pollack said in a statement that preventing violence is central to hospitals’ missions.

“Keeping people healthy is at the heart of healthcare, and violence runs counter to that,” Pollack said. “It’s our hope that quantifying the resources hospitals and health systems commit illustrates the enormity of this issue as a public health problem while giving hospitals the chance to highlight their efforts to keep their communities and workplaces safer.”

SEATTLE—Three executives from Japan loom large in a cramped courtroom here—at least their photos do, mounted on a white poster board propped in front of the jury.

“They were the key decision-makers,” one attorney said during opening arguments to a lawsuit brought by a local widow against a giant Tokyo-based medical device maker.

Theresa Bigler’s case is the first to go to trial in the U.S. stemming from a series of deadly superbug outbreaks across the country that were linked to contaminated medical scopes. She is suing Olympus Corp., claiming that one of its tainted devices caused the infection that led to her husband’s death in August 2013. The Olympus executives, her attorneys say, remained silent for too long about a design flaw that hindered cleaning of these reusable scopes.

The executives, however, will not be testifying. “Each is currently under criminal investigation and would potentially risk their freedom to attend,” Olympus said in a May 22 court filing. Each executive invoked his Fifth Amendment right against self-incrimination in depositions late last year in Tokyo.

Richard Bigler, 57, was one of at least 35 patients in American hospitals to have died since 2013 after developing infections tied to Olympus duodenoscopes—flexible, lighted tubes used to peer deep inside the body. More than 25 patients and families, from California to Pennsylvania, have sued Olympus alleging wrongful death, negligence or fraud.

“We could prevent more flu-related deaths by vaccinating more of our children and teenagers,” says a CDC investigator.

By Erin Schumaker/The Huffinton Report/News/March 4, 2017.

The majority of kids who died of the flu between 2010 and 2014 didn’t receive their yearly vaccine for influenza prior to their deaths, according to a study published in the journal Pediatrics on April 3.

“The lower percentage of vaccination among those who died suggests that the vaccine prevents deaths due to flu,”Brendan Flannery, lead author of the study and epidemiologist at the U.S. Centers for Disease Control and Prevention, told The Huffington Post.

“We could prevent more flu-related deaths by vaccinating more of our children and teenagers,” he added.

The study, which examined 358 confirmed flu deaths in kids ages 6 months to 17 years, found that of the 291 children whose vaccination status could be determined, only 26 percent had received that year’s flu vaccine. (This percentage didn’t include children who had been vaccinated less than 14 days before their deaths, because it takes about that long for the vaccine to take effect.)

Approximately half of the children who died between 2010 and 2014 had at least one high-risk medical condition, such as a neurological disorder, diabetes, asthma, heart disease or an immune deficiency, which can increase susceptibility to influenza complications. And although the flu vaccine is especially important for high-risk people, only 31 percentof the high-risk children who died in that period had been vaccinated, according to the study.

“Parents of children with high-risk conditions often know that their children are at increased risk of severe illness if they get the flu,” Flannery noted. “It was surprising therefore that only one in three children with underlying risk factors for severe flu had been vaccinated.”

Among the healthy children who died of the flu, just 20 percent had received a seasonal flu vaccine.

Researchers determined the flu vaccine was 51 percent effective in high-risk children and 65 percent effective in low-risk kids.

“The vaccine is not perfect and some children in this study died from flu despite receiving [the] vaccine,” Flannery said. “However, flu vaccines are the best way to prevent against getting the flu, and this study reminds us that flu can be deadly, even in previously healthy children and adolescents.”

Among adults, influenza-related deaths ranged from a low of 12,000 seasonal flu deaths to a high of 56,000 seasonal flu deaths between 2010 and 2014, according to the CDC. (The agency uses estimates rather than exact counts for adult influenza deaths because flu deaths tend to be underreported on death certificates and not all states are required to report them.

Also, some people who die from flu complications aren’t tested for the flu.)

This reporting is brought to you by HuffPost’s health and science platform, The Scope.

Patients are less likely to die within 30 days of admission if they happen to be treated at hospitals at the same time The Joint Commission arrives for a surprise inspection.

The reason for the better mortality rates during the unannounced on-site surveys compared to weeks before and after the surveys may be due to the fact that clinicians are aware they are under scrutiny and are therefore more vigilant, according to the new study published Monday in JAMA Internal Medicine.

NASHVILLE, Tenn.—Though the annual RISE Summit takes place in “Music City,” the 2017 conference began with a discussion about what’s going on in the nation’s capital.

The reason, according to CenseoHealth Chief Strategy Officer Nathan Goldstein, is simple.

“Every one of us works at a job deeply influenced by what happens in Washington,” he said during the RISE chairpersons’ opening remarks.

With that in mind, keynote speaker Howard Fineman—an NBC/MSNBC political analyst and global editorial director of The Huffington Post Media Group—offered an insider’s view of the current climate within the Beltway now that President Donald Trump is in power.

Many new administrations come to the White House with a combination of a “burst of energy” and confusion about the complicated task of governing, he said, but with the exception of perhaps the Carter administration, “nobody has come in knowing less about how it all works than the Trump people.”

The Trump administration nevertheless is very sure about the way it wants to run the government, he added, and Democrats are just as determined to impede the Republicans’ agenda.

“I’ve never seen the city this divided into warring, distrustful and mutually exclusive camps,” Fineman said.

That contentious political climate also colors Republicans’ plans to repeal and replace the Affordable Care Act, according to Fineman.

Donald Trump’s presidency has “raised worrying questions about its likely impact on science and health policy,” write several BMJ editors in an editorial published online today.

The administration seems to place little value on facts or analysis, and may not be considering the consequences of its pronouncements and policies on biomedical research and the health of Americans and citizens around the world, the authors said. The editorial was written by José Merino, BMJ US clinical research editor, Elizabeth Loder, BMJ head of research, Kamran Abbasi, BMJ executive editor, and Ashish Jha, who is KT Li professor of health policy at the Harvard TH Chan School of Public Policy.

“We are particularly concerned that Trump’s administration is acting in ways that will suppress research and limit communication on scientific topics that it deems politically inconvenient,” wrote the authors.

Updated January 30, 2017. Football is said to be the most popular sport in America. Polls show that professional football has held the top spot in the hearts of US sport fans for the past 30 years. In terms of youth sport participation, football comes in third place behind basketball and baseball. Participation in high school football declined by 2.3% in 2012-2013 compared with 2008-2009. With participation in all organized youth sports (age 6-17 years) on the decline, this might reflect a general trend toward inactivity, but football faces the extra hurdle of concern about concussions and other injuries that can cause permanent harm.

These concerns are well-founded. Recent data show that 61% of retired players in the National Football League (NFL) report having had a concussion. Among 5- to 24-year-olds, football is a leading cause of visits to emergency departments for nonfatal injuries, easily outnumbering motor vehicle-related injuries among teenage boys.

Watching from the safety of a sofa or stadium seat is one thing, where the greatest dangers to one’s health are posed by alcohol, high-calorie snack foods, and prolonged sitting. But playing the game brings risk of another order of magnitude. The constellation of football-associated injuries is wide, ranging from the well-known contact head injuries to heat stroke, stress injuries, catastrophic joint injuries, rhabdomyolysis, and even sudden death. In 2014, six fatalities were directly related to football played at any level. In time for Super Bowl LI, Medscape brings you this review of common and not-so-common injuries and events associated with this sometimes dangerous sport.